I had a chance recently to visit the new School of Medicine at the University of Virginia with a team of educators with whom I work. We went in search of the learning studio which has garnered a great deal of media coverage and which I discovered, not from local coverage, but through a post at the FischBowl, Karl’s blog. It seems ironic that I’d traveled virtually to a Colorado post to discover a gem of a learning treasure in my own backyard. After reading the post, I googled more information and then had one of those experiences in which I thought, “Why am I not talking with my son’s roommate, a member of the medical class of 2014?
Here’s what I discovered from online research, chat-time, and the visit. The radical innovations touted in articles about the School of Medicine are the real deal. This is not your family doctor’s medical school. The transformation of this program cuts across learning spaces, curriculum, teaching, learning project work, assessment and grading, and learning technologies, all of which have been integrated into a learning system designed to engage medical students in high levels of Bloom’s thinking processes. The end in mind? The program’s designed to create physicians who serve patients well. Here’s an image that the staff uses to illustrate their prescription for educational change:
NxGen Curriculum: Across the board, sweeping changes have been made to the curriculum by abandoning the discipline-in-isolation model that has held sway for well over a hundred years in medical schools. Instead, the UVa medical school faculty now integrate content relevant to the practice of medicine, discarding discipline-based content that’s not connected to serving patients. The days of students following a prescriptive series of courses in anatomy, physiology, biochemistry and so on are over, beginning with the current crop of first-year students. As the associate dean indicated, “We want to cull from disciplines the clinically relevant components that are important to take care of patients.”
Teaching: The planning committee realized that a change in curriculum had to be accompanied by a change in teaching practice. The new case study approach parallels its use in other graduate programs such as business and law. A key to why this approach both challenges and engages can be found in the push of student learning teams to apply, synthesize, analyze and evaluate while pulling relevant content from the integrated content curriculum. The days of eight-hour rote learning lectures have been abandoned in favor of patient-based case studies that are staged inside a learning studio for four hours at a time. Professors facilitate singly or in teams, pausing to teach more informally from a central location. When students spend time in more of a presentation format, they interact using strategies such as think-pair-share. Teaching in this model represents a flipped classroom approach with learning of relevant content assigned for work outside of class time.
Learning Work: The new learning model promotes increased engagement and interactive learning whether working with “standardized patients” in the Clinical Skills Center, learning skills using full body, high-tech mannequins in the Simulation Center or analyzing cases with team members in the learning studio. Why? The Associate Dean of the School of Medicine says that medicine is best practiced in a team rather than as a solo practitioner model, a shift born from research using patient diagnostic data.
The faculty also noted in making the change from lecture to learning work that the majority of students were not participating in lectures, often skipping them and learning content outside of class anyway. Survey data collected in 2008 by the medical faculty led to the conclusion that changes in pedagogy had become critical to engaging students. It seems to be working as one first-year student described her reaction to this new model,
“ Interactive learning here facilitates long-term learning. Applying our learning helps us take it to the next level.”
Assessment and Grading: The faculty also have moved from assessments of mainly rote learning to a more balanced assessment system using case studies as a key component of summative assessments, in particular. Students take formative assessments online every other weekend with a final online assessment at the end of each unit of study. Daily online quick checks of content learning take about five minutes at the beginning of class. Each assessment garners points towards a performance-based grade based on standards. Variables that once were used to accrue credit (behavior, attendance in lectures, etc.) no longer are counted in the new standards-based grading system. Students who do not master expectations have the opportunity to study and retake tests. This mastery system is designed to promote successful learning among all students, not failure.
Learning Technologies: Learning through contemporary technologies is ubiquitous in the School of Medicine. Students use personal response systems to provide feedback and respond to questions during their work with faculty. The central lectern demands that faculty use multiple technologies for demonstration purposes, to share case work from any of 30 student teams (6 each), or for assessment. Faculty considers PowerPoint to be a dead presentation approach that “depresses” learning rather than engaging learners. In the two practice centers, Simulation and Clinical Skills, the use of work stations allow faculty to watch or guide teams working with either living “standardized patients” or high-tech mannequins and provide students with real-time performance feedback. In fact, the simulation centers are so realistic that the “docs in training” respond physically (heart rate and blood pressure) similarly to actual practice.
Paper texts are a thing of the past for these medical students. Digital content is available from publishers as well as created by faculty. Students and faculty favor the use of web resources such as 3-D anatomy because 3-D resources are better representations of the body than cadavers, an old technology learning tool.
Learning Spaces:The new School of Medicine represents a holistic approach to learning. Students access multiple spaces; the simulation centers, learning studio, a state of the art learning auditorium, and a lounge space complete with gaming capabilities as well as a baby grand piano.
The learning studio represents a significant transformation from lecture halls of the past. It’s borrowed from the TEAL model put into place at MIT to reduce failures in freshman physics. Students work in teams at round tables (the associate dean says round tables support team learning while square tables separate students) that allow each team to project from a tablet PC onto one of several drop down screens around the circumference of the round room.
A high-tech lectern sits in the middle of the room and any time faculty use it, they teach to multiple presentation spaces, not a dominant teaching wall. Often, faculty co-facilitate learning studio work, sharing their cross-disciplinary expertise.
Faculty development: A new curriculum taught in very different learning spaces, using new technologies, demands new pedagogical approaches. The associate dean talks of the old lecture model as one of “egocentric control.” He shares when he was a student that the days of textbook reading, lecture, and memorization demanded a lot of repetitious work, but not a lot of brain power. He sees the work of students in this year’s class as being far more rigorous than the work he did as a student or assigned as a faculty member. At the same time, the highly motivated group of young people in this first-year class already have impressed faculty members and older medical students with the quality of their questions and depth of knowledge. One lab supervisor commented,
“The questions that these students ask blew me away. I would never have been able to formulate a question like they were asking when I was a first-year medical student.”
For teaching faculty to undertake shifts in teaching practice, assessment and learning expectations, they’ve engaged in over 160 hours of pedagogical coursework. The staff admit it’s been a challenge for some. However, the faculty’s work as learners alongside medical students reaffirms Jefferson’s vision of an Academical Village as well as that of the associate dean who’s led the transformation of UVa’s medical education program, “Here students, residents, practitioners, and teaching docs are all defined as learners.”
My Impressions: I feel as if I’ve seen the near future of what education can be. The medical faculty planners at the University considered the art of possibilities and have taken the risk to create a system of radical innovations in medical education. They did it because they believe it’s what contemporary medical students need today to become the practitioners of tomorrow. They threw out 100 years of tradition and in doing so have created a cutting edge model for both higher education and secondary schooling.
The learning studio looks more like an elementary classroom than anything else. The student lounge reminds me of a photo from the Mozilla offices in California. The auditorium’s set up as a working space, not a listening place. And, the simulation centers remind me of the doctors’ offices, emergency rooms and surgical centers we all have occasion to visit. It’s rigorous and relevant learning that feels like the real world of medicine.
This shift did not come cheaply for the University in staff time, new facilities, or learning resources. However, the investment seems well worth the costs of educating these first-year medical students. I’d like to see this kind of investment in transforming education across America. This kind of learning does not come cheap, but it’s learning to hold dear. Imagine if the billions being spent by the USDOE could support this kind of innovation work. Imagine Technology Enhanced Active Learning (TEAL) in secondary classes everywhere. If the top 1% medical students who attend UVa and the top 1% math-science majors at MIT need this kind of learning, isn’t it a no brainer that all kids would benefit?